The successful surgical treatment of a paradoxical embolus to the carotid bifurcation.

Journal of Vascular Surgery

PubMedID: 11296346

McKinney WB, O'Hara W, Sreeram K, Hudson JA, Solis M. The successful surgical treatment of a paradoxical embolus to the carotid bifurcation. J Vasc Surg. 2001;33(4):880-2.
Paradoxical embolism is a rare cause of ischemic stroke. We report the case of a 67-year-old man who had a saddle embolus to the carotid bifurcation successfully treated with emergency embolectomy. Transesophageal echocardiogram revealed a large patent foramen ovale and an easily demonstrable right-to-left shunt. Subsequent investigations revealed proximal deep venous thrombosis in the left femoral and popliteal veins and multiple pulmonary emboli. Long-term anticoagulation was instituted for the diagnosis of paradoxical embolism. The patient's recovery was uneventful, and he remained neurologically intact. A literature review emphasizes the role of transesophageal echocardiography and suggests that paradoxical embolism may be a more common cause of stroke than previously thought.